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Subspecialty sign-out is increasingly common in academic medical centers as well as some community practices. Reducing interobserver variability in anatomic pathology is desirable so that clinicians can select the appropriate therapy. Many departments that elect subspecialty sign-out do so with the assumption that it will improve diagnostic accuracy and interobserver variability-but does it? The literature is mixed.The proper handling of the gross specimen is imperative, as it is the most important first step in providing excellent patient care. Our diagnoses depend on the correct description and submission of tissue sections for histologic analysis. A logical and problem-solving approach to handling the gross specimen is presented.Art in nursing is present in various forms and there is ample literature exploring creativity, including journaling for clinicians, intensive care unit diaries for patients and providers, and music therapy for patients. Illness narratives, depictions of the sick, or the effects of disease are commonly represented in media. This article highlights how creativity and various mediums of artistic expressions may can be used as a self-care practice and aid in boosting empathy in health care providers. Gandotinib solubility dmso Theories on empathy are presented as well as selected representations of nursing as creative expressions and the importance of promoting creativity and empathy.Burnout is reaching epidemic levels among health care providers. It negatively impacts individual providers, the care team, facility, and patients. Increased employee turnover, job dissatisfaction, and conflict are found whenever staff becomes burned out. Patient outcomes and satisfaction are negatively impacted. Although burnout is increasing in health care, much can be done to change the level of burnout and improve employee satisfaction. Individuals can learn the factors that lead to burnout and specific actions that can help prevent and recover from burnout. This information can be used to transform health care and decrease burnout and its effects.The need for self-care in critical care nurses is recognized on a national level. Stress, unhealthy lifestyles, and chronic disease in the general population is mirrored in nursing, affecting burnout, retention, quality outcomes, and well-being. Integrative approaches to promote well-being are supported by nursing theories and tools such as the Integrative Health and Wellness Assessment (IHWA). Through coaching techniques and the IHWA, nurses can support their self-development via self-assessment, self-reflection, self-evaluation, and self-care. This article discusses the role of the IHWA and a coaching process to aid critical care nurses in implementing sustainable self-care strategies.Critical care nurses frequently provide end-of-life and bereavement care. This type of care is rewarding, but can put nurses at risk for moral distress, compassion fatigue, and burnout. By incorporating self-care into their routine, critical care nurses minimize this risk and maintain their own health and well-being. This article provides suggestions for promoting physical, emotional, and spiritual self-care for nurses caring for dying intensive care unit patients and their families. A case scenario illustrates the importance of this concept. Practical examples of self-care are highlighted along with discussion on how leadership can support self-care and maintain a healthy work environment.Academicians who maintain a critical care clinical practice encounter numerous stressors, especially during the COVID-19 pandemic, which can influence well-being. This article provides historical perspectives on the stressors inherent in working in the critical care environment as well as the stressors of working in the academic environment. It proposes the application of the synergy model as a framework to help improve the well-being of academicians who practice and teach critical care. The most valuable strategy to improve professional well-being is for organizations to take a systems approach. The article focuses on approaches that are potentially within each individual's control.Burnout-a combination of emotional exhaustion, depersonalization, and a diminished sense of individual accomplishment-is a serious issue for critical care nurses. Burnout has been examined as an individual's emotional state, but burnout is also a social phenomenon that may spread among colleagues through emotional contagion. Current interventions to reduce burnout are either person directed or organization directed; few interventions focus on the critical care nursing team and their social support and interactions. This article reviews burnout in critical care nursing through the lens of emotional contagion. We offer suggestions for team-based interventions to address burnout in critical care nurses.Ethically challenging situations are an increasing phenomenon in the nurse's environment, and literature on the subject is growing. Morally challenging experiences common in the critical care environment include end-of-life situations, barriers to providing the best care possible, and lack of organizational resources. These experiences can lead to moral distress and subsequent negative impacts on the clinician. Emerging in the literature are strategies to address the impact of moral distress through the development of moral resilience. Moral resilience is gained through personal commitment and organizational support.Intensive care unit (ICU) nurses report some of the highest levels of stress and burnout because they are exposed to excessive workloads, end-of-life concerns, prolonged care, and ethical dilemmas. Supporting ICU staff through self-care and mindfulness programs is successful in improving stress and burnout and in promoting resilience. Addressing barriers to engaging in self-care practices and identifying unit-specific needs are important to consider when implementing wellness programs. Micro-restorative practices can alleviate immediate stress generated from patient care and provide a moment of peace in busy ICUs. Leadership and organizational support are vital in identifying the need for and promoting wellness programs.Healthy nurses are essential for optimizing population health, patient care experiences, and health care cost-efficiency. Critical care nurses are at increased risk of developing physical and psychological symptoms due to their high-stress work environment and exposure to traumatic events. There is growing recognition for the value of implementing nurse-centered, team-based, and organizational-wide levels of intervention designed to mitigate the impact of high work stress and trauma on health professionals. The central assertion of this article is that meaning and joy in nursing practice are contributors to professional well-being and part of the solution for achieving the quadruple aim.Astrocytes are the most abundant glial cell in the central nervous system and are involved in multiple processes including metabolic homeostasis, blood brain barrier regulation and neuronal crosstalk. Astrocytes are the main storage point of glycogen in the brain and it is well established that astrocyte uptake of glutamate and release of lactate prevents neuronal excitability and supports neuronal metabolic function. However, the role of lipid metabolism in astrocytes in relation to neuronal support has been until recently, unclear. Lipids play a fundamental role in astrocyte function, including energy generation, membrane fluidity and cell to cell signaling. There is now emerging evidence that astrocyte storage of lipids in droplets has a crucial physiological and protective role in the central nervous system. This pathway links β-oxidation in astrocytes to inflammation, signalling, oxidative stress and mitochondrial energy generation in neurons. Disruption in lipid metabolism, structure and signalling in astrocytes can lead to pathogenic mechanisms associated with a range of neurological disorders.

Hepatic steatosis and gallstone disease are highly prevalent in the general population; the shared risk factors are age, ethnicity, obesity, insulin resistance, metabolic syndrome, atherosclerosis, risk of cardiovascular disease, and mortality. The presence of insulin resistance is the critical element in this association because it represents a crucial link between metabolic syndrome and non-alcoholic fatty liver disease, as well as a higher susceptibility to gallstone formation.

An exhaustive search engine investigation of gallstone disease, cholecystectomy, and liver steatosis latest literature was made.

Clinical studies and systematic reviews suggest an association between gallstone disease, cholecystectomy, and hepatic steatosis.

The bidirectional relationship between liver steatosis and gallstone disease and cholecystectomy is summarized in the role of insulin resistance, lipid metabolism, bile acids signaling pathways regulated by transcription factors expression, and to the gallbladder physiological role; however, more epidemiological and experimental studies should be complemented.

The bidirectional relationship between liver steatosis and gallstone disease and cholecystectomy is summarized in the role of insulin resistance, lipid metabolism, bile acids signaling pathways regulated by transcription factors expression, and to the gallbladder physiological role; however, more epidemiological and experimental studies should be complemented.

Determine the effect of visual-based motor and cognitive dual tasking on postural stability in those with anterior cruciate ligament reconstruction relative to matched controls.

Cohort study.

Fourteen volunteers with history of anterior crucaite ligament reconstruction were matched with fourteen healthy controls. Participants performed single leg balance tasks under 4 conditions (1) single leg balance with eyes-open, (2) single leg balance while catching a ball (dual-motor), (3) single leg balance while repeating a string of numbers in reverse order after viewing them (dual-cognitive) and (4) single leg balance with eyes-closed. Participants completed several patient-reported outcomes of knee function. Mixed effects models were used to identify group differences on the center of pressure measures of ellipse area and root-mean-squared excursion (medial-lateral and anterior-posterior). The mixed models included subject pair as a random factor and group (control, anterior cruciate liagement reconstruction)reater postural instability during the dual-cognitive condition that may indicate unique neural processing deficits remain following anterior cruciate ligament reconstruction.

To assess pharmacy preceptors' perceptions of the benefits of and barriers to a layered learning practice model (LLPM) at their practice site.

An online survey was created using Qualtrics and sent to experiential directors at all colleges [or schools] of pharmacy in Ohio and at Big Ten universities. The experiential directors were asked to send the survey to all preceptors affiliated with their program. The survey assessed the perceived or actual benefits of and barriers to a layered learning model. Benefits and barriers to patient care, student or resident learning, and the practice site were assessed.

In total, 304 surveys were initiated by precepting pharmacists. Survey respondents reported precepting introductory pharmacy practice experience students (n= 113, 37.1%), advanced pharmacy practice experience students (n= 184, 60.5%), and residents (n= 176, 57.9%) throughout a given year. Survey respondents' most commonly identified benefits of a LLPM included an increase in patient access to pharmacy team members (n= 97, 42.